Last semester, just two weeks before graduation, Eileen Cartter ’16 began experiencing severe abdominal pain. She went to the Cox Health and Counseling Center and was diagnosed with a urinary tract infection (UTI) and prescribed a course of antibiotics. But that diagnosis did not sit well with Cartter.
“It just didn’t sound like my symptoms,” Cartter, former chief copy editor for the Collegian, said. “But I took the meds, and I hoped to feel better.”
A few days later, Cartter’s pain only increased. A call from the nurse practitioner who drew her blood for testing alerted Cartter that her white blood cell count was extremely high — potentially indicating an infection — and that she would have to go to the emergency room immediately.
“She actually drove me to the hospital,” Cartter said. “They did a bunch of tests there and told me my appendix had probably burst. I went into surgery that Friday, which was a week and a day before graduation.”
Cartter’s case is an extreme example of an inaccurate diagnosis made by Health Center staff, but one of several cases in recent years. These diagnoses can be a result of improper or incomplete assessment of student symptoms, exacerbated when students make premature visits to the Health Center or neglect to follow up when a conditions changes or worsens. w
“There’s a huge subjective piece to being a medical provider — a person may go to three or four different medical providers and be told three or four different things,” Certified Nurse Practitioner and Director of Health Kim Cullers said. “In my experience, that doesn’t mean that person is wrong. That means that’s four different opinions about what might be happening at that particular time.”
“That frequently happens in the world of healthcare,” Cullers added. Many students visit the Health Center when they have had symptoms for fewer than 24 hours, which can make it difficult for health providers to make an accurate diagnosis. “There are many kinds of conditions that evolve and give you clues to what might be going on over time,” Cullers said.
For example, Cullers said, infectious mononucleosis (mono) can present with a wide array of symptoms: Some students come in with a mild sore throat, while others just feel fatigued. Mono diagnoses are further complicated because the test used to verify the diagnosis looks for antibodies that may not initially be detectable.
Cullers also highlighted how many different variables go into making a diagnosis, including experience, education, training, physical exam findings and test results. To diagnose patients, Health Center staffers examine their vital signs, physical examinations, medical history, symptoms and exposures, among other factors.
Some students who reported inaccurate diagnoses from Health Center staffers attributed this to a lack of thoroughness in their examinations. But students, too, play a role in the health providers’ abilities to provide accurate diagnoses.
“I went to the Health Center and they told me I had a cold. And they asked if I wanted to do a strep test, but I said no — I didn’t think I had strep,” Nora Hamovit ’17 said. “The nurse practitioner I saw that time didn’t push me to take the test, and agreed with me that it was probably just a cold.” Hamovit’s symptoms worsened. A few days later, she returned to the Health Center and was promptly diagnosed with strep throat. “It wasn’t so much a misdiagnosis as a lack of thoroughness.” Hamovit said. “The nurse probably should have pushed the strep test.”
Misdiagnosis can be an inaccurate term because an illness may appear one way when it first presents and another way when a provider looks at it later, according to Cullers. “I personally have seen students who have come with a sore throat, and I have examined their throat and it looks fine,” Cullers said. “Twenty-four hours later, though, that student will come back and present differently — tonsils are swollen, fever is high — which changes treatment completely.” The slow presentation of many common illnesses that afflict students, combined with the speed that students react to early signs of illness, mean that students who do not follow up on Health Center appointments do not receive the treatment they need.
But not every student who is scheduled to return to the Health Center is guaranteed a correct diagnosis. When Gabe Jimenez-Ekman ’19 visited the Health Center this semester with a potentially infected hangnail, he was prescribed a general antibiotic and told to return in a week, or if the hangnail significantly worsened. It did, so Jimenez-Ekman returned to the Health Center several days later. “That nurse just kind of popped it and opened up, and told me that it was responding really well to the antibiotics,” he said. “At no point did anyone take a culture of any kind.”
The next day, Jimenez-Ekman’s finger had become more swollen and painful, so he went to Knox Community Hospital, where he was diagnosed with a staph infection resistant to the antibiotics he was taking. “The doctors at urgent care were shocked that the Health Center hadn’t taken any cultures or tried to figure out what it was,” Jimenez-Ekman said. “I probably would have had to go on IV antibiotics.” But he doesn’t blame the Health Center staff. “I don’t hold resentment for the Health Center, I just think it’s a problem with funding and paying for more tests,” Jimenez-Ekman added.
Cullers said she does not believe the Health Center lacks the resources necessary to adequately care for students, but she would like to add a staffer focusing on preventative care and wellness. She also expressed an interest in educating students on how to stay well and take care of their illnesses. “I feel really good about what we do here,” Cullers said.